title: Third-line hormonal treatment with exemestane in postmenopausal patients with advanced breast cancer progressing on aminoglutethimide: a phase II multicentre multinational study. Exemestane Study Group.
abstract: In a European multicentre phase II study, 80 postmenopausal patients (pts) with advanced breast cancer progressing on aminoglutethimide (AG) at daily doses of > or = 500 mg were enrolled. Seventy-eight received exemestane (200 mg daily orally), including 33 pts resistant to prior AG, 39 pts who had progressed after an initial response to AG, and 6 pts whose response to AG was either unavailable or not evaluable. Three pts were pretreated with AG only, 69 with tamoxifen and AG, and 6 with tamoxifen, AG and other hormone therapies; 55% had also previously received chemotherapy. The predominant site of disease was visceral in 34 cases, bone in 27 and soft tissue in 17. Based on Peer Review assessment, the overall objective response rate (CRs plus PRs) was 26% (12% in pts resistant to AG and 33% in AG-responsive pts). Disease stabilisation > or = 24 weeks was achieved in an additional 13% of patients (15% of those resistant to AG and 13% of those AG-responsive), resulting in an overall success rate of 39% (28-50, 95% confidence interval). The median duration of objective response, overall success and median TTP were 59, 48 and 21 weeks, respectively. Toxicities were usually mild to moderate in severity, with hot flushes (21%), nausea (19%), dizziness (12%), weakness (12%), increased sweating (12%), androgenic symptoms (10%) and peripheral oedema (9%) as the most common side-effects. Only 2 pts (3%) discontinued treatment due to adverse events. These results are very promising considering that exemestane was administered as third- or fourth-line hormonal treatment in most cases and confirm previous observations about the lack of cross-resistance when steroidal aromatase inhibitors are sequenced with the non-steroidal aromatase inhibitor AG.
authors.affiliation: Department of Internal Medicine C, Kantonsspital, Gallen, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Thürlimann
authors.forename: R
authors.initials: R
authors.lastname: Paridaens
authors.forename: D
authors.initials: D
authors.lastname: Serin
authors.forename: J
authors.initials: J
authors.lastname: Bonneterre
authors.forename: H
authors.initials: H
authors.lastname: Roché
authors.forename: R
authors.initials: R
authors.lastname: Murray
authors.forename: E
authors.initials: E
authors.lastname: di Salle
authors.forename: S
authors.initials: S
authors.lastname: Lanzalone
authors.forename: M G
authors.initials: MG
authors.lastname: Zurlo
authors.forename: G
authors.initials: G
authors.lastname: Piscitelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000616:Aminoglutethimide / Q000008:administration & dosage / Q000009:adverse effects; D000730:Androstadienes / Q000008:administration & dosage / Q000009:adverse effects; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D016896:Treatment Outcome
chemical_list: D000730:Androstadienes; D018931:Antineoplastic Agents, Hormonal; D000616:Aminoglutethimide; C056516:exemestane